Director, Denial Transformation Services

Job Purpose

The Director, Denial Transformation Services develops and assists with leading the strategy to improve yield performance through denial mitigation process improvement initiatives. The Director, Denial Transformation Services will collaboratively work with clinical and revenue cycle department leadership to perform deep dive analysis on clinical and technical denials for their respective client(s), utilizing multiple analytics tools and data sources to identify trends and opportunities for improvement relative to all denial types. The Director, Denial Transformation Services applies high level critical thinking skills to perform root cause analysis on denied accounts to identify denial trends. This position is client-facing and will serve as the primary point of contact for their assigned client base and oversee the completion of denial prevention committee reports and summaries, lead monthly denial prevention committee meetings, establish and maintain client relationships to drive best practice implementations, and utilize sound judgment and experience to aggregate and advance team recommendations for correcting underlying issues resulting in denials.

Duties & Responsibilities

• Provide relevant guidance and work to resolve issues identified through analysis of denial trends
• Review individual denials to determine why they occurred
• Professionally and effectively communicate with hospital contacts to recommend corrective and denial preventative actions and coordinate meetings and training sessions, as necessary
• Participate in Denial Prevention Task Force or Committee with assigned client leadership, covering necessary information relative to identified denial trends, progress from prior actions, and next steps
• Establish strong relationships with appropriate stakeholders/committee members, including Finance Leadership, Revenue Cycle, Managed Care, and hospital department leadership teams
• Oversee documentation and trends prevention-related findings to track results of executed denial mitigation plans
• Initiate and/or contribute to the creation of reports as needed, with the goal of providing relevant management information for tracking and trending problems and measuring improvement against best practices benchmarks
• Lead reviews using all patient accounting, host and related systems used across their client to verify and summarize trends concisely with recommendations for corrective actions
• Aggregate and provide strategic advisory perspective related to process improvement and quality in the assessment of root cause issues contributing to denials by collaborating with the subject-matter experts and applicable owners to make recommendations to remedy process, system, and education issues
• Utilize materials and train revenue cycle staff, leadership, committee members, and hospital department leaders on denial-related trends and root cause issues impacting their client
• Perform other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• Bachelor’s degree in business or related discipline required; degree in Healthcare Administration, Business, or related discipline preferred
• Certified Revenue Cycle Representative (CRCR) preferred
• 5+ years of experience in hospital revenue cycle roles with 2+ years of experience in a management position in hospital revenue cycle industry
• Background and familiarity with various hospital Accounting and EMR Systems
• Solid ability to analyze, interpret and present data in meaningful ways
• Project Management and data analysis experience preferred
• Proficiency in Microsoft Office Suite with intermediate to advanced Excel and Access skills required
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented 
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.